Pupil-dependent performances of EDOF lenses in eyes with post-LASIK spherical aberration

Current refractive extended depth of focus (EDOF) intraocular lenses (IOLs) are sensitive to the level of corneal spherical aberration (SA), and some exhibit pupil-dependent performances. As laser-assisted in situ keratomileusis (LASIK) can significantly alter corneal SA, the purpose of this study was to assess the impact of spherical aberration changes after refractive surgery on the pupillary behavior of EDOF IOLs. Three commercial EDOF IOLs (AcrySof IQ Vivity, Bausch and Lomb LuxSmart, SIFI MiniWell) were simulated using literature-based data. The performances of these lenses, in terms of through-focus visual acuity, range of field, CDVA and DCIVA, were evaluated in a Liou and Brennan eye model. This model was adapted to take into account different pupil sizes and spherical aberration values, representing respectively normal eyes and eyes that had undergone hyperopic or myopic (average/strong) refractive surgery. Corneal spherical aberration (SA) induced by LASIK surgery significantly altered the pupillary behavior of all EDOF lenses. Hyperopic LASIK shifts the location of the best visual acuity towards positive defocus values, increases the range of field, may decrease CDVA while improving DCIVA. Conversely, myopic LASIK induced SA shifts the location of the best visual acuity toward negative defocus values, decreases the range of field, and may improve CDVA while degrading DCIVA. Post-refractive surgery corneal spherical aberration significantly affects the performance of EDOF IOLs with pupil diameter. A thorough understanding of each IOL’s pupil-dependent behavior, such as the ones presented in this study, is essential for optimal lens selection and power calculation before refractive surgery.